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Step-by-step manual for planning and performing bifurcation PCI: a resource-tailored approach Ticagrelor plus aspirin for 1 month, followed by ticagrelor monotherapy for 23 months versus aspirin plus clopidogrel or ticagrelor for 12 months, followed by aspirin monotherapy for 12 months after implantation of a drug-eluting stent: a multicenter, open-label, randomized superiority trial Generalizing Intensive Blood Pressure Treatment to Adults With Diabetes Mellitus Variation in Revascularization Practice and Outcomes in Asymptomatic Stable Ischemic Heart Disease Mode of Death in Heart Failure With Preserved Ejection Fraction Non-invasive detection of coronary inflammation using computed tomography and prediction of residual cardiovascular risk (the CRISP CT study): a post-hoc analysis of prospective outcome data Burden of 30-Day Readmissions After Percutaneous Coronary Intervention in 833,344 Patients in the United States: Predictors, Causes, and Cost Management of No-Reflow Phenomenon in the Catheterization Laboratory Incidence of contrast-induced acute kidney injury in a large cohort of all-comers undergoing percutaneous coronary intervention: Comparison of five contrast media Defining High Bleeding Risk in Patients Undergoing Percutaneous Coronary Intervention: A Consensus Document From the Academic Research Consortium for High Bleeding Risk

Clinical TrialDecember 2017, Vol 248, P120–123, [Epub 2017 Aug]

JOURNAL:Int J Cardiol. Article Link

Bare metal versus drug eluting stents for ST-segment elevation myocardial infarction in the TOTAL trial

Lavi S, Iqbal J, Cairns JA et al. Keywords: Bare metal stent; Drug-eluting stent; STEMI

ABSTRACT

BACKGROUND - The safety and efficacy of drug eluting stents (DES) in the setting of ST elevation myocardial infarction (STEMI) is not well established.


METHODS - In the TOTAL trial, patients presenting with STEMI were randomized to routine thrombectomy versus PCI alone. In this post-hoc analysis, propensity matching was used to assess relative safety and efficacy according to type of stent used.


RESULTS - Each propensity-matched cohort included 2313 patients. The composite primary outcome of cardiovascular death, recurrent MI, cardiogenic shock or class IV heart failure within one year was lower in the DES group (HR 0.67; 95% CI 0.54 to 0.84, p=0.0004). Cardiovascular death (HR 0.61; 95% CI 0.43 to 0.86, p=0.005), recurrent MI (HR 0.51; 95% CI 0.35 to 0.75, p=0.0005), target vessel revascularization (HR 0.47; 95% CI 0.36 to 0.62, p<0.0001) and stent thrombosis (HR 0.60; 95% CI 0.40 to 0.89, p=0.01) were lower in the DES group. There was no difference in major bleeding between groups.


CONCLUSIONS - In this observational analysis, the use of DES was associated with improvement in cardiovascular outcomes compared to the use of BMS. These results support the use of DES during primary PCI for STEMI.